The Connecticut Office of Health Strategy signed off on YNHHS’s certificate of need, or CON, application to buy Waterbury Hospital, Rockville General Hospital and Manchester Memorial Hospital from Prospect Medical Holdings. Negotiations for YNHHS to acquire the financially troubled hospitals have been ongoing since October 2022. 

The state’s approval of the CON greenlights the way for YNHHS to finalize the terms of the acquisition deal with Prospect Medical Holdings, keeping the hospitals from shuttering their doors. The acquisition would see YNHHS expand its total bed count by 700 and add about 4,400 additional employees, for a total of approximately 33,400. The for-profit Prospect hospitals would also be reverted to non-profit status.

“I am glad that all the parties have been able to reach an agreement on this transaction in a way that ensures that the residents who live in each of the hospitals’ host communities will continue to have local access to essential medical care, and the jobs of the employees who provide this care will be preserved under this new ownership,” Connecticut Governor Ned Lamont wrote in a statement. 

For over a year, Yale New Haven Health has been in negotiations with Prospect Medical Holdings and the state to iron out an agreement to acquire the three, Prospect-owned hospitals.

Following a six-week-long cyberattack on the three hospitals last August, Yale New Haven Health proposed a “Recovery Plan” that lowered its originally proposed purchase price of $435 million and asked the state to provide financial assistance for the deal. In return, the system would provide the three hospitals with support in their efforts to recover from the cyberattack.

Shortly after, negotiations between Yale New Haven Health, Prospect and Connecticut’s Office of Health Strategy for the acquisition deal went confidential to ensure that they continued as efficiently as possible.

“We continue to meet with all parties, including the Connecticut Office of Health Strategy and Prospect, CT to bring the transaction to a successful conclusion,” said Dana Marnane, director for public relations at Yale New Haven Health, in an email to the News in October.

State conditions on YNHHS

The new CON contains 46 conditions that the state’s Office of Health Strategy, or OHS, will require Yale to adhere to, including the hiring of an independent monitor for five years that reports to the OHS at the sole expense of YNHHS. 

“The [Independent Monitor] shall be responsible for monitoring NewCo’s compliance with all of the conditions set forth in this Agreed Settlement and shall produce a schedule of required reports and data to be shared with the [OHS],” the CON stated. 

Many conditions work to ensure current employees at the three hospitals can maintain their jobs. Notably, the agreement requires YNHHS to rehire all non-management employees and use their “best efforts … to minimize the elimination of individuals’ jobs.” YNHHS must also recognize all established bargaining agreements between hospital employees and the previous management. 

Other conditions focus on community-building efforts. YNHHS and the Prospect hospitals must have community representatives on its board of directors. In addition, the hospitals must hold community meetings to engage the public with hospital activities that allow community members to ask questions. 

The hospitals will also work with local health organizations and stakeholders to conduct a Community Health Needs Assessment to systematically identify community needs. To increase accessibility, YNHHS will also make culturally and linguistically appropriate services available and integrated into the hospitals’ operations. 

All three hospitals will adopt the YNHHS financial assistance policies, and all hospitals will continue to offer Medicaid services. Further, YNHHS must increase its aggregate community benefit expenditures across each hospital. 

“For-profit ownership of community hospitals — especially when tied to hedge funds — should never again be tolerated in our state,” John Brady, vice president of the statewide labor federation AFT Connecticut, wrote in an email to the News. “We have been consistent on our priorities – the health and well-being of our communities and caregivers.”

For five years, Northeast Medical Group — the medical foundation associated with YNHHS — will offer semi-annual reports on Medicaid patients’ access to specialty treatments, including medication-assisted treatment for substance misuse, dermatology, ENT services, neurology, orthopedics, and pain management. 

YNHHS will also invest $6 million in behavioral health services that target increasing access to mental health and substance use disorder treatment. 

“With today’s approval by the Office of Health Strategy, I encourage Prospect to work with Yale to reach a deal that will allow them to finalize this purchase and bring a much-needed resolution to this transaction,” Lamont wrote.

Healthcare providers, legislators push to finalize deal

Throughout the negotiation process, many healthcare professionals, legislators and health policy experts around the state have urged the deal should move forward, and should do so as quickly as possible.

Of concern to these individuals is the volatile financial status of Prospect Medical, and the effects that its for-profit business model has had on its hospitals’ ability to provide care.

Following the cyberattacks, State Senator Saud Anwar, co-chair of the Connecticut General Assembly Public Health Committee, told the News in October that the hospitals could not bill their patients or pay medical supply vendors.

As a result, the CT Mirror also reported that the state was also forced to provide a $7 million bailout to the hospitals, which were struggling to stay afloat after being unable to receive Medicaid reimbursements during the attacks. 

“This was a perfect storm from the hospitals’ perspective,” Anwar wrote in an email to the News. “They were already struggling financially, and the fact that their medical records and ability to see as many patients as they usually see, as well as their ability to bill patients as normal, resulted in a financial issue that harmed cash flow, making their ability to manage their finances significantly more difficult.”

Prospect owes the state at least $67.39 million in health provider taxes that date back to March 2022, according to three state tax liens filed against the California-based company. 

The company’s financial struggles and alleged mismanagement have generated widespread frustration among several Connecticut healthcare providers, who told the News that they continue to support the YNHHS purchase of the Prospect hospitals.

Those financial difficulties “call attention to the dire need for responsible, committed new ownership of ECHN’s hospitals,” said Diane Carlson, president of the Manchester Federation of LPNs and Techs United, AFT Local 5144, who works as a licensed practical nurse at Manchester Memorial Hospital. 

The state’s approval of the CON greenlights the way for Yale to finalize the terms of the acquisition. 

“Our patients and our caregivers deserve better than a hedge fund that fails to pay its fair share to the communities from which it profits,” she added.

According to Rep. Jason Doucette, D-Manchester, the state representative for one of the towns containing a Prospect hospital, Prospect’s management style has “negatively affected” the availability of vendors and supplies. 

He believes that Prospect’s financial woes also harm the morale of doctors, nurses and other hospital employees.

“The private equity model of doing business in health care, together with [Prospect’s] inability to refinance certain company debts, then compounded by the cyber attack in mid-2023, created a dire situation where the bills simply weren’t getting paid,” he wrote in an email to the News. “Most of the people I speak to in the community are hopeful that the acquisition by Yale will bring a significant overall improvement to the ECHN system generally, and that frankly anything is likely to be better than the current situation.”

As the deal moves forward after the state’s approval, however, healthcare professionals continue to provide care to Connecticut residents, even as they face uncertainty over future management and job prospects.

Annie-Marie Cerra, president of AFT Local 5055 for Manchester Memorial Hospital Nurses and an emergency department nurse at Manchester Memorial, highlighted healthcare workers’ continued commitment in an email to the News.

“This acquisition process has created a lot of anxiety for all of us. Despite that, our member nurses and health professionals – as well as our physician colleagues – have shown up every day in our hospitals to provide the excellent care our patients and their families deserve.”

Yale New Haven Hospital was founded as the General Hospital Society of Connecticut in 1826.

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Two years ago, Yale New Haven Health agreed to acquire three financially-troubled hospitals in Connecticut. 

Now, the deal is on unsteady footing in the wake of a six-week long cyberattack against the hospitals, with YNHH requesting to pay a lower price and receive financial support from the state.

The attack targeted Manchester Memorial, Rockville General and Waterbury Health Hospitals — the medical centers that YNHH is poised to acquire, which are currently owned by the Los Angeles-based company Prospect Medical Holdings.

YNHH proposed a flurry of changes to the acquisition deal in an attempt to address the hospitals’ financial issues, many of which were exacerbated by the cyberattack. Under its “Recovery Plan,” YNHH would provide management services to all three hospitals to aid their recovery from the cyberattacks. 

In the meantime, according to YNHH’s plan, Prospect Medical Holdings would decrease the purchase price of the three hospitals — originally $435 million — and Connecticut’s state government would lend financial support for the deal. With the acquisition, YNHH would gain over 700 new beds and add about 4,400 additional employees, for a total of 33,400. The for-profit Prospect hospitals would also be reverted to non-profit status.

Dana Marnane, director of public relations and communications for Yale New Haven Health, emphasized the need for communication between the players involved in the acquisition process regarding the hospitals’ current financial situations.

“We need everyone to sit down to get a full understanding of the current financial condition of Waterbury and [Eastern Connecticut Health Network] hospitals, including the impact of the recent cyberattack, and determine a path forward,” said Marnane.

Cyberattack worsens financial status of Manchester Memorial, Rockville General and Waterbury Hospitals

Early in August, the Eastern Connecticut Health Network — which includes the Manchester and Rockville hospitals — and Waterbury Health experienced a simultaneous systemwide network outage. That outage was later identified to be the result of a halting cyberattack on the Prospect Medical Holdings company.

In August, the CT Mirror previously reported that Manchester Memorial issued multiple “divert notifications” to emergency responders. These messages indicated that they could not accept patients to their emergency room. The hospitals closed their ER to new patients 29 times and canceled more than half of elective surgeries. At all three hospitals, staff individually monitored patients as they lacked functional technology, causing staffing shortages to surge. 

The attacks may also have compromised the personal information — including social security numbers — of over 24,000 Prospect Medical Holdings employees.

Information released to employees explained that the attack occurred between July 31 and Aug. 3. AFT Connecticut — the workers’ union representing almost 1,000 registered nurses and allied health professions in five local unions at Manchester Memorial and Rockville General Hospitals — statewide vice president John Brady said the attack was then discovered through an investigation on Sept. 13.

However, Brady said, employees only learned of the breach on Sept. 29 — almost two months after it originally occurred. While employees lacked official communication about the cyberattack and data breach, Brady said, the effects of the attack were clear in the workplace.

The attacks also caused severe financial challenges for the Prospect hospitals.

State Senator Saud Anwar, co-chair of the Connecticut General Assembly Public Health Committee, told the News that the hospitals were not able to properly bill their patients nor pay their medical supply vendors, creating a financial roadblock for the facilities that worsened their already-deteriorating financial statuses.

As a result, the CT Mirror also reported that the state was also forced to provide a $7 million bailout to the hospitals, which were struggling to stay afloat after they were unable to receive Medicaid reimbursements due to the attacks. 

“This was a perfect storm from the hospitals’ perspective,” Anwar wrote in an email to the News. “They were already struggling financially, and the fact that their medical records and ability to see as many patients as they usually see, as well as their ability to bill patients as normal, resulted in a financial issue that harmed cash flow, making their ability to manage their finances significantly more difficult.”

Strained finances and Prospect’s past

Negotiations for the acquisition are occurring during a period of financial strife for YNHH. In 2022, the system lost $240 million on the heels of the COVID-19 pandemic: a deficit that forced YNHH to fire 72 hospital managers during the worst fiscal year in its history. This year, YNHH budgeted for an even larger $250 million deficit.

Prospect Medical Holdings, which owns 20 for-profit hospitals around the country, is also plagued by a checkered history. In 2018, CBS News reported that its owners took out a $1.12 billion loan, using proceeds to pay themselves and their shareholders a $457 million dividend. To pay it back, the company sold land and buildings in three states — including Connecticut — to a real estate investment trust and leased the hospitals back.

In 2019, according to a ProPublica investigation, Connecticut’s Joint Commission on Hospital Accreditation initially denied Waterbury’s accreditation — which is required for facilities to receive Medicare and Medicaid funding — after finding 42 quality standards out of compliance. In one case, according to the investigation, the hospital had failed to monitor two actively suicidal patients. After one patient died, the hospital failed to inform police.

Yale New Haven Health’s ‘Recovery Plan’

In light of the cyberattacks and the hospitals’ deteriorating financial conditions, YNHH proposed an amended deal that would allow them to purchase the hospitals for a lower price. 

Dana Marnane, director of public relations and communications at Yale New Haven Health, said that the proposed YNHH “Recovery Plan” is essential to ensure that the three hospitals stay afloat.

“Yale New Haven Health proposed a Recovery Plan in which Yale New Haven would provide immediate management support to [Waterbury Health] and ECHN to help them recover from the cyberattack,” Marnane wrote in an email to the News. “Prospect would adjust the purchase price and the State would provide financial support to the [Waterbury Health] and ECHN hospitals to account for their deteriorating condition. We need all parties, including the State, to join in the Recovery Plan to make this transaction happen.”

Prospect Medical Holdings did not respond to multiple requests for comment.

State legislators, including Anwar and Governor Ned Lamont, along with YNHH, Waterbury Health, ECHN, and Prospect Medical Holdings officials will convene in a special meeting within the next week to discuss the proposed plan and the progression of the overall acquisition deal.

Along with the challenges of providing continued care to patients, Anwar mentioned concerns over the Prospect hospitals’ outstanding bills. 

“Many vendors have not been paid and that’s why I sense a need of urgency of moving forward with the acquisition so that a stronger health care system can provide support and change the trajectory of health care systems still struggling at this time,” Anwar said. “I hope vendors understand that as soon as a transaction happens, things will improve.”

Anwar also mentioned the importance of the upcoming meeting to move the deal along. 

An influx of cash from the YNHH acquisition could do more than pay Prospect’s bills to vendors; it could keep the hospitals from closing down, he said. 

“YNHH does have an excellent record and provides very high-quality care, and has been collaboratively working in many communities”,  Anwar added. “Hospitals have the ability to generate their own funding, but they do need some investment and technical know-how to improve quality of care and increase capacity.”

The acquisition has been met by hesitation from some officials, including Ted Doolittle, the state’s former appointed healthcare advocate, who say that patients might face higher prices.

The deal would mean that, alongside the Hartford HealthCare system, YNHH would own over half of all hospitals in Connecticut. 

“It could be good, but it’s probably more likely to be a net negative for the families in the state,” Doolittle told the News last year.  “When hospitals do merge and expand, the end result is that the prices paid by consumers and families and insurance companies tend to go up.”

According to the American Hospital Directory, there are 51 hospitals in Connecticut. 

The National Suicide Prevention Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a certified listener, call 988. 

Crisis Text Line is a texting service for emotional crisis support. To speak with a trained listener, text HELLO to 741741. It is free, available 24/7 and confidential.

To talk with a counselor from Yale Mental Health and Counseling, schedule a session here. On-call counselors are available at any time: call (203) 432-0290.  Appointments  with Yale College Community Care can be scheduled here.

Students who are interested in taking a medical leave of absence should reach out to their residential college dean.

Additional resources are available in a guide compiled by the Yale College Council here.

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Almost to the day of its 52nd anniversary, Mandy Cohen MED ’05, the new director of the U.S. Centers for Disease Control and Prevention, and many of Connecticut’s top elected officials attended a groundbreaking celebrating the center’s expansion. 

The center now has over 300 staff members who treat patients regardless of their ability to pay. More than 90 percent of the center’s 32,000 patients are Black or Hispanic, and the vast majority are at less than half the federal poverty line. 

Joining Cohen, Governor Ned Lamont, Rep. Rosa DeLauro, Sen. Richard Blumenthal and Manisha Juthani, commissioner of the state’s Department of Public Health, urged Connecticut residents to get updated COVID-19 booster shots — asking for patience following reports of vaccine shortages across the nation. Lamont and DeLauro also received their vaccines during the press conference. 

“With today’s groundbreaking we are poised to face the next 52 years of providing high-quality care,” Suzanne Lagarde, the CEO of Fair Haven Community Health Care, said. “We know that the task is a big one, but we stand on the shoulders of our predecessors. They were the true giants and we are emboldened by their energy and their mission.”

Center plans for significant expansion

The center’s expansion is its first capital project since its founding. In preparation for the project, the clinic bought and tore down adjacent properties in late 2022, including three Woolsey Street houses, five apartments and a pizza shop. 

In their place, the center plans to build a new neighborhood clinic and community space, which will merge existing exam rooms and build 18 new ones to create a total of 27 more spacious patient rooms. The center will also add a pharmacy and laboratory to the space. 

After the new building opens in 2025, the clinic hopes to expand the number of patients it sees from 32,000 to more than 65,000 per year.

Thursday’s groundbreaking was also attended by state attorney general William Tong, state senator Martin Looney, state comptroller Sean Scanlon and New Haven mayor Justin Elicker. The officials lauded Lagarde for her ability to secure funding and approval to expand the site. 

“A lot of busy people are here today and only Christine Lagarde can gather people like this,” Elicker said. 

Center touts long history of care for vulnerable populations 

The center was founded after a group of Fair Haven activists came together to provide culturally sensitive health care for Fair Haven’s historically underserved population.  

Fair Haven has a majority Hispanic/Latino population and had a median household income of $45,966 in 2022, far below the U.S. median of $74,850. 

Growing from a school room with an original budget of $5,000, the center moved into its current buildings in the 1980s, after hiring their first staff. Now, the clinic is a Federally Qualified Health Center that receives federal funding and has been heralded as a national model by Xavier Bercerra, secretary of the Department of Health and Human Services. 

Maria Melendez, one of the center’s founding members and a speaker at Thursday’s groundbreaking, described the clinic’s early days to attendees. 

“Day after day we worked with many agencies and groups and community representatives to achieve the goal we had of treating people in a new way,” Melendez said. 

Cohen, the CDC director, also spoke about the national importance of federally qualified health centers like the Fair Haven clinic. Since the nation’s first Community Health Center opened in 1965, these federally-funded health centers now serve more than 30 million people across 1,400 centers. 

Cohen added that the center was an important resource during the height of the COVID-19 pandemic and continues to be an important location for people to receive their COVID-19 boosters. 

Lamont, DeLauro receive booster 

At the conference, Cohen told Connecticut residents to get the most recent versions of the COVID-19 vaccine, following their approval by the U.S. Food and Drug Administration in September.

Four million people have received the updated COVID-19 vaccine, Cohen said, following a surge of cases in August and September. Even after a previous COVID-19 infection or vaccine, the body’s protection against the virus wanes. Getting the booster, Cohen said, is important to keep the body’s defenses up-to-date.

She also emphasized the importance of receiving routine flu shots. And after the FDA’s and CDC’s green-light earlier this year, she highlighted the importance of new vaccines for respiratory syncytial virus — known also as RSV — for older adults above the age of 60. 

“This fall and winter, we’re going to have three viruses circulating, if not more — respiratory viruses that we didn’t know we’d be dealing with,” Cohen said. “By getting this updated vaccine, it allows your body to be in the best fighting shape it possibly can be.”

To boost confidence in the vaccine, Lamont and DeLauro received their booster shots during the press conference. They also emphasized that the vaccine is now free for all, regardless of insurance status. 

Cohen, Lamont and Juthani acknowledge booster rollout hiccups in the state 

In the past, the federal government purchased and distributed vaccines in bulk, making them free for everyone. Now, that is no longer the case: vaccine coverage is handled through the private sector, much like doses of other immunizations. 

Even without government buyouts, however, the vaccines will still be free for everyone. According to Blumenthal, private insurance companies are required to cover COVID-19 boosters for individuals not on government healthcare plans like Medicare and Medicaid. Out of pocket, the shots can cost over $100.

“Insurance companies should be reaching out to people who were denied coverage, because they’re entitled to reimbursement,” Blumenthal said. “If you got the shot, and you’ve had to pay anything for it, you should go back to your insurance company and get reimbursed.”

For those without private insurance, Cohen highlighted the CDC’s Bridge Access Program, which covers free vaccines at retail pharmacies, such as CVS or Walgreens, and at health centers for uninsured or underinsured individuals. 

The state also covers vaccinations for children. 

“There is a vaccine for free with your name on it,” Cohen said. “Go out and get it today to protect yourself.”

The officials also addressed reports of vaccine shortages and canceled appointments. Juthani said that she had her booster appointment for the COVID-19 vaccine canceled before it was rescheduled a few days later. 

DeLauro and Cohen cited the transition from government to private healthcare providers for the current set of boosters as a potential cause for delays.

“They are learning a lot of lessons about the challenges of distribution,” Cohen said. 

However, Juthani clarified that the situation should be improving as “kinks get worked out.”

Juthani said that supply is increasing daily and estimated that the state should have adequate supply and distribution by the end of October.

The first COVID-19 vaccines were released on Dec. 11, 2020 through an FDA emergency-use authorization.  

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Unveiled at an April 20 meeting on Yale’s West Campus, the Laboratory-in-a-Van initiative aims to bring public health services to historically underserved communities. Using a van retrofitted with laboratory-grade diagnostic equipment, the mobile clinic will employ SalivaDirect — a saliva-based COVID-19 PCR test developed at YSPH — to facilitate on-site testing with a turnaround time of two to three hours. 

“It is a brilliant way to reduce the barriers to testing, instead taking the lab to communities who may be less likely to — or unable to — access the necessary clinic or labs,” Anne Wyllie, one of the project’s principal investigators and the creator of the SalivaDirect testing process, wrote to the News. “We are actively working with our community partners to identify how we can best serve their communities.”

The mobile lab project is funded by the National Institutes of Health’s RadX Underserved Populations program. According to Brittany Choate, the SalivaDirect program manager, the funding will allow the mobile clinic to administer 400 free SalivaDirect COVID-19 tests for uninsured patients through the end of 2023.

To do so, Choate and the mobile lab team are collaborating with city health departments — including those of New Haven and West Haven. The mobile clinic is also partnering with community organizations such as the Alliance for Living, Columbus House, Liberation Programs and the APT Foundation.

Last week’s West Campus announcement of the mobile lab program also included a meeting between YSPH and YPL officials and representatives from these regional partner groups to propose ideas for how to best utilize the van. According to Wyllie, her team is now working to finalize the van’s first appointments.

Within a month, she said, the van should be operational.

“We’re engaging with these community partners because we want to work with them and be respectful of the relationships that they have with their communities, with their constituents and with their clients,” Choate said. “We’re going to be able to partner with them to coordinate where the mobile lab van can go and deploy in conjunction with existing community events. And hopefully, [we can] use that connection with community partners to build trust and … be more effective as a result.”

Earlier in the pandemic, the SalivaDirect team had partnered with Flambeau Diagnostics, a biomedical company specializing in mobile lab testing, to expand access to mobile saliva-based COVID-19 testing. According to Wyllie, the new YSPH and YPL initiative utilizes one of the former Flambeau vans that had been retrofitted for clinical testing.

To outfit the van for administering SalivaDirect, Kat Fajardo, a SalivaDirect lab manager, opted to utilize two portable pieces of equipment to conduct the PCR tests.

The first is a Mic, or Magnetic Induction Cycler, which is a portable PCR machine that can run 46 specimens at a time, according to Fajardo. At six inches by six inches, the Mic leaves a “small footprint on the van itself” while leaving extra space in the van’s benches.

Ordinarily, Fajardo added, PCR machines in laboratories are considerably larger. Given the small size of the Mic machine, the van’s lab technicians can work with specimens on the van’s benches while running a PCR test at the same time. 

The other piece of equipment is a Myra, a portable robotic liquid handler designed to automate the process of moving clinical specimens between vials. Together, according to Fajardo, both the Mic and the Myra work “hand in hand,” to conduct PCR testing. 

“What we wanted to do is run high complexity testing in the van, with a reduced timeframe,” Fajardo said. “And then be able to get the results out to the patients as soon as we possibly can, within a designated two to three hour timeframe.”

According to John Sinard, director of clinical operations at Yale Pathology, a mobile pathology laboratory can bring testing to individuals without a “formal association” with the healthcare system. 

A standard van that collects specimens, he explained, needs to bring samples back to a central lab before getting results to patients — steps that require a patient to have an “identified healthcare provider.” 

With a mobile laboratory, Sinard added, testing can be completed on site and the patient can directly access the results without an intermediary provider.

However, according to Wyllie, the mobile lab will not solely conduct SalivaDirect COVID-19 tests. She expects that the van will also provide more comprehensive public health outreach, including distributing health communication and education materials, supporting vaccination efforts and screening for other infectious and chronic diseases.

Fajardo also described an interest in expanding the van’s capabilities to include tests for other upper respiratory viruses such as influenza, RSV and human metapneumovirus, as well as possible STD testing. 

According to Fajardo, conducting multiplex testing in the van — screening for multiple diseases at the same time — could provide a crucial way to track upper respiratory viruses during flu seasons.

“Let’s say you have an event going on, like a concert, and vans have popped up over the weekend on the [New Haven] Green,” Fajardo said. “So these people who don’t have access to medical care, or even insurance, can come to the vans and test there.”

In order for this initiative to be impactful, both Sinard and Choate emphasized the importance of developing relationships with community organizations that have earned the trust of historically underserved New Haven communities.

Those relationships with community organizations, Choate explained, are a two-way street: public health experts are able to access communities that might be skeptical of health interventions, while also being able to tailor outreach to the communities’ needs.

“Having that trust and engagement with community partners that have been well established is essential for being able to offer these kinds of services,” Choate said. “That way, they can act as ambassadors on our behalf. Beyond that, community leaders can then help us inform the outreach that we’re doing.”

Moving forward, Choate aims to obtain funding to sustain the mobile lab program beyond 2023, especially as the pandemic — per the federal government’s standard — is coming to a close. 

By using the van as a pilot, she hopes to continue offering accessible tests and demonstrate the effectiveness of mobile testing options.

Sinard, however, remains aware of the challenges associated with ensuring high-quality mobile testing. While the team’s on-site evaluation procedures ensure that the van’s testing is as accurate as those conducted in a YSPH or YPL laboratory, mobile testing poses new obstacles.

“This is a new adventure for us,” Sinard wrote. “The mere size of the van and the amount of equipment and reagents which it can accommodate does limit the range of testing which can be offered at any one time. There are also some regulatory hurdles which [need] to be addressed.”

Yet, Choate remains optimistic about the potential of mobile lab testing. She described how the SalivaDirect team is exploring how to use saliva to detect other diseases, including monkeypox and, potentially, diabetes.

Community partners, she explained, are also eager to understand how “mobile deployments” can be used for community health issues beyond COVID-19 and pandemic preparedness.  

“How can we be using these mobile vans for other community health concerns such as gun violence or mental health?” Choate said. “And how can we use these mobile deployments and be able to pop up in communities to offer public health services or education going forward?”

The Yale School of Public Health was founded in 1915.

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State harm reduction advocates and government officials hope that the United States Food & Drug Administration’s March 29 decision to authorize over-the-counter distribution of Narcan — a nasal Naloxone spray that can reverse the effects of an opioid overdose  — will help save the lives of people who are overdosing.

As opioid overdoses continue to rise in New Haven, Narcan remains unavailable over-the-counter without a prescription. While naloxone is currently distributed at community-based organizations and health departments, New Haven city officials, Connecticut state legislators and harm reduction advocates believe that Narcan will reach local store shelves — on an over-the-counter basis — by the end of the summer.

“I want to emphasize that New Haven experiences some of the highest numbers of drug-related overdoses in Connecticut, which should be a prioritized concern for the Yale community,” wrote Winnie Ho, co-chair of the Yale Addiction Medicine Collaborative. “Narcan’s prescription-only nature has been a persistent barrier towards getting it out quickly and in adequate amounts, to the people who need them.” 

Due to its ability to rapidly save the life of an individual who has overdosed, the FDA has approved Narcan use without a prescription — opening up avenues for Narcan to be purchased locally in grocery stores, convenience stores and other such locations.

“Naloxone saves lives,” Kathryn Hawk, an associate professor of emergency medicine and a specialist in addiction medicine, wrote to the News. “It provides an important opportunity to discuss strategies to reduce harm, including infections and overdose risk, the increasing presence of fentanyl in the street opioid and cocaine supply, and an opportunity to discuss treatment options if patients are ready.”

However, even as the official over-the-counter rollout begins, advocates have also raised ongoing questions about the pricing and availability of Narcan.

According to Hawk, it is “critically important” that over-the-counter naloxone availability does not lead to a reduction in existing channels of the medication to drug users, especially since, even with OTC status, cost and stigma continue to be ongoing barriers to naloxone access.

Frederick Altice, the director of the Yale Center for Clinical and Community Research, noted that making Narcan OTC has “potential pitfalls.”

Altice expressed concerns over the price of the OTC medication, which, without insurance, can reach $120 for two intranasal doses. High prices over the counter, Altice warned, could reduce the overall distribution and availability of Narcan.

Altice also told the News that Narcan plays a key role as a medium of drug education. Obtaining naloxone from a clinic, for instance, is often accompanied by education on recognizing an overdose and how to administer the medication. 

“Naloxone works best as part of a package of overdose education and NLX distribution,” Altice wrote. “We lose the overdose education aspect.”

Ho told the News that she still remains concerned about the price point and potential logistical issues surrounding access to Narcan as it becomes more widely available. 

According to Ho, the generic forms of Narcan have not yet received authorization, and there have also been reports of supply chain issues with the brand name drug. 

“Some concerns that I have heard include: What’s the price of Narcan going to be, if only one formulation of naloxone, by one company, is approved for OTC, if this form of naloxone is no longer prescription-status … and what will the implementation of this new authorization look like?” Ho wrote to the News. “Will it help or hurt community distribution?” 

Advocates in the city are also already reporting issues with shortages of naloxone, which has further raised concerns about the feasibility of ensuring that the over-the-counter drug continues to be easily accessible. 

Julia Einhorn, the New Haven Health Department’s programs director, expects Narcan to “hit store shelves” by late summer. She noted that the delay between FDA authorization and widespread Narcan availability was due to “extra steps” that medication manufacturers need to complete before distributing Narcan to stores.

“We’re committed to expanding access to harm reduction services by connecting them to substance use treatment and other supports and services,” New Haven Mayor Justin Elicker told the News. “A critical part of that effort is providing naloxone training and free access to naloxone, which is available through both the city’s health department and our community partners — and that will continue irrespective of Narcan’s availability at pharmacies.”

Altice, however, described the delay as being driven by a shortage of availability. In his experience, there is “not enough [Narcan’] to go around.”

In the meantime, according to Einhorn, the city plans to continue distributing naloxone and  providing naloxone training even once the medication becomes available over-the-counter. The city aims to use social media and partnerships with schools and community organizations, Einhorn said, to raise awareness for these initiatives. 

For harm reduction advocates, however, over-the-counter authorization is just one step in the fight against overdose-related deaths.

“While over-the-counter status for Narcan is a step in the right direction towards reducing barriers to access, I personally believe that the ultimate goal is to ensure that naloxone is free and readily available for all,” Ho told the News. “We’ve lost too many people to still have this many barriers to a life-saving medication.”

The first patent for naloxone was issued in 1961. 

The post New Haven plans for late summer distribution of Narcan appeared first on Yale Daily News.

To quantify that burden, Denary and her team at the YSPH Housing and Health Equity Lab published a report identifying the link between rental assistance, food insecurity and nutrition intake. Published in the April edition of journal “Preventive Medicine,” their study found that tenants in rental assistance programs were less likely to experience food insecurity and consumed more daily cups of fruits and vegetables than those on program waitlists.

“When it comes to housing and food security, the two are linked,” Denary told the News. “And being able to alleviate one aspect of that, ideally, will help with another. If we use rental assistance as a proxy to take away the housing affordability dilemma that so many households are having, can they be able to afford better food security than they otherwise would?”

To examine how rental assistance affects food security and nutrition in low-income households, the researchers used food security and nutrition data from the National National Health and Nutrition Examination Survey, or NHANES. They then linked that data with housing records from the Department of Housing and Urban Development, which provides a database of individuals who received rental assistance between 1999 and 2016. 

However, according to Andrew Fenelon, an assistant professor at Penn State University and one of the YSPH team’s collaborators, studying the health impact of rental assistance programs is “difficult.” Individuals receiving rental assistance already tend to experience economic hardship — or homelessness — that exacerbate health disparities.

“These untoward life events can increase the risk of poor health, and can make it more likely that a household experiences food insecurity,” Fenelon said. “So if one does a simple comparison of families receiving rental assistance to those renting market-rate units, it might appear that rental assistance leads to poor health and food insecurity.”

By linking the two databases, the researchers could create a more accurate control group for families receiving rental assistance. 

They then divided the data into two groups: those receiving assistance when they entered the NHANES database and those who would eventually receive rental assistance within two years — a typical wait period for families seeking entry into rental assistance programs.

In theory, Fenelon added, the waiting-period group should experience similar socioeconomic determinants, varying only in that they have not yet received “the benefit of the program.” As a result, he said, the researchers were able to more accurately assess the effects of the programs themselves, rather than “picking up” other factors that would affect the health outcomes of rent-burdened individuals.   

Analyzing the results, the team recognized that project-based housing assistance was correlated with a decreased likelihood of food insecurity, as measured by metrics from the NHANES survey. 

Likewise, rent-assisted individuals consumed 0.23 more daily cups of fruits and vegetables on average than those in the control group. 

When the researchers further broke down the data by the type of rental assistance, they found that only project-based assistance was tied to statistically significant increases in fruit and vegetable consumption. However, both project and voucher based housing were positively associated with increased fruit and vegetable consumption. 

“The major implication then is that investments in housing have benefits beyond just shelter, including improving household food access and healthy food consumption, which may in turn improve health outcomes for these families,” Fenelon wrote in an email to the News. “This is important evidence for housing advocates and policymakers hoping to support further investments in affordable housing, especially given the wide health disparities we see in the United States.”

For Denary, the link between rent burden and food accessibility makes sense. Oftentimes, she explained, families facing high housing costs choose cheaper food or products with a long shelf life rather than healthier, more expensive alternatives. 

Especially for families with kids, parents with more limited expendable income often prioritize feeding their kids above themselves.

“Doctors will often recommend that people with diabetes eat more fruits and vegetables, and those changes can be expensive,” Denary said. “Their pocketbooks will dictate what their food choices are more so than what their doctors recommend for them.”

According to Denary, the study was a part of the Housing and Health Equity Lab’s ongoing investigation into the link between rental assistance, nutrition and diabetes. To continue exploring that relationship, she explained, the lab is tracking a cohort of 120 individuals in Connecticut with diabetes who are on rental assistance waitlists.

Over two and a half years, they intend to monitor diabetes metrics like A1C levels, blood pressure and glucose levels to assess how their diabetes status and management behaviors change as the individuals transition to rental assistance programs. The researchers also plan to conduct a series of longitudinal interviews on a subset of those individuals throughout the study. 

Denary noted that they hope to complete data collection in 2025. 

According to Kasia Lipska, an endocrinologist and Associate Professor of Medicine at the Yale School of Medicine who collaborated on the study, diabetes care can be “complex and challenging” for patients experiencing unstable housing. Improving outcomes for her patients with diabetes “means addressing their housing needs.”

“Social determinants of health play a critical role in shaping outcomes for patients with diabetes,”  Lipska wrote in an email to the News. “Our research suggests that many of these social determinants of health are interconnected … all critical to the health and well-being of people living with diabetes.”

According to Karen DuBois-Walton ’89, Executive Director of the Housing Authority of the City of New Haven, the link between health outcomes and housing makes housing an urgent issue. The government’s failure to meet housing needs, she added, is “unconscionable” and requires “continued advocacy by people in every community. 

“The clear connections between housing and health are borne out by this study and many more,” Dubois-Walton wrote in an email to the News. “Housing is essential to health, education, employment and all other wellbeing outcomes and must be a priority of local, state and federal officials and policy makers.”

However, Luke Melonakos-Harrison DIV ’23, a member of the Connecticut Tenants Union, pushed back on the notion of  rental assistance programs as the solution to housing shortages and spiraling rent. Instead, Melonakos-Harrison favors social housing initiatives, rather than rental assistance, as a means to address high rental costs.

“[Rental assistance] programs funnel public funds into the pockets of private investors and are laden with burdensome and disciplinary regulations on tenants,” Melonakos-Harrison said, “While social housing can solve the same problems without publicly funding the real estate industry.”

Even so, for members of the research team, investigating rental assistance produces research that informs the lives of people struggling with rental costs. 

Denary, for instance, pointed to rental assistance as a means to “save people money down the line.” By reducing the health consequences of unstable housing, she added, policies like rental assistance could healthcare costs and allow individuals to better manage their health. 

Denary also emphasized rental assistance as a research-tested tool to combat the high rent burden and adverse health consequences.

“Housing is linked to health, point blank,” Denary told the News. “We’re able to say that rental assistance does alleviate this rent burden, and it does subsequently have health benefits for folks that obtain it and are able to stay within the program. We really recommend that [policymakers] prioritize spending in this area for people to be able to have healthier lives.”

YSPH is located at 60 College St.

The post YSPH study links rental assistance with increased food security and nutrition appeared first on Yale Daily News.

Led by the Yale Center on Climate Change and Health, the Climate Change and Health certificate is an 18-week digital curriculum targeted at career professionals who aspire to learn more about the links between a changing planetary climate and global health outcomes.

Though the program was launched four years ago, its recent relaunch, according to its administrators, brings on a slate of new faculty and a refined focus on two key themes: the impacts of climate change outside the United States and an examination of climate change through the lens of social justice.

“Science is continuing to emerge and update, and so the goal is to give people access to the most recent science so that they’re aware of how [climate change] is impacting human health,” said Daniel Carrión, the academic director of the certificate program. “One of the opportunities to improve was to make sure that we are covering more content about other parts of the world, and then to do a more explicit job bringing in issues of justice and equity as we think about climate change.”

The revamped Climate Change and Health Certificate is the continuation of an online certificate program launched in 2018 and initially helmed by Robert Dubrow, faculty director of the Yale Center on Climate Change and Health. With the redesign of the curriculum, Carrión takes over for Dubrow as the program’s academic director. This spring’s cohort will be Carrión’s first time facilitating the certificate program.

Historically, according to Lauren Babcock-Dunning, the director of online and certificate education at YSPH, cohorts have ranged from 80 to 100 students in each of the program’s eight previous iterations. The certificate has catered to professionals at different stages of their careers — from physicians and healthcare providers to epidemiologists, advocates and entrepreneurs. 

“There are so many professionals out there who are not going to go into an MPH on climate change and health but who still want to learn about this topic,” Carrión told the News. “We need the skill sets of not only clinicians, but of urban planners, of people in nonprofits doing work on environmental conservation, and so on to be thinking about this intersection of climate change and health. Offering this bite-sized certificate for folks who aren’t going to pursue an entire degree is a means of doing that.”

Throughout the online program, students take three six-week courses: “Introduction to Climate Change and Health,” “Climate Adaptation for Human Health” and “Communicating Climate Change and Health.” The certificate program supplements asynchronous online content with live discussion groups moderated by a faculty member specializing in climate change and health. 

Babcock-Dunning also emphasized a “remarkably high” completion rate for the program in the past — a metric she attributes to “proactive” measures to check in on students who have missed assignments and the accountability of a live class with professors who are well versed in the subject matter.

“A cohort of learners go through the program together so that they form strong relationships with each other,” Babcock-Dunning said. “And with the program faculty, they engage in discussions on the content. I think that forms a very collegial and rich learning experience”

As part of their redesign of the program, the program’s faculty members shifted the courses’ content to emphasize climate change impacts outside the United States and situate climate impacts in the context of social equity.

For example, rather than just examining climate change’s impact on Lyme disease in the United States, according to Carrión, the program now incorporates case studies of malaria in sub-Saharan Africa or dengue fever in the Caribbean. Additionally, Carrión added, case studies include theories of structural stigma to examine the impact of a climate-related event on the health of marginalized populations.

In September, the certificate program hired Elena Grossman — a senior research specialist at the University of Illinois, Chicago, whose work focuses on climate change and health equity — as the lecturer for the program’s second course, “Climate Adaptation for Human Health.” 

Grossman came to the Climate Change and Health certificate program from 10 years of research and program development into climate resilience in Illinois. In addition to Carrión, she is also joined by Kristin Timm, a research associate with the Alaska Climate Adaptation Science Center and the director of the certificate’s third course on climate communication strategies. 

As part of the redesign process, Grossman sought feedback from previous program participants, who, she said, sought a “practical perspective.” As a result, she centered her course’s content around real-world examples of climate adaptation strategies, evaluating their effectiveness, challenges and utilization of an “equity lens.”

“Thinking about these different types of strategies is using a matrix of health equity, climate change mitigation and adaptation,” Grossman told the News. “How successful is a strategy at addressing climate change mitigation, adaptation and equity? Does it have a big impact on health equity? And how do you go about the process of selecting a strategy for a community?”

As students complete the program, according to Babcock-Dunning, they join a group of over 650 alumni. Many incorporate knowledge about climate change and health into their own careers. According to Carrión and Babcock-Dunning, some alumni changed their professional trajectories to focus on climate and health.

A few of those in academic positions have also launched their own programs in climate change and public health. One alum, according to Carrión, expanded their mental health practice to help address climate change-related anxiety.

“The reality is that climate change is a global problem with a big local impact,” Grossman told the News. “We can learn from other locations, and they can learn from us. This is a battle that we’re all in and it’s all hands on deck: we all need to listen and learn.”

The Climate Change and Health Certificate will launch its redesigned program on April 10.

The post YSPH Revamps Climate Change and Health Certificate appeared first on Yale Daily News.

Without even being allowed to say goodbye to her, Sasha was deported to Russia for “re-adoption” by a Russian family. According to a recent report from the Yale School of Public Health’s Humanitarian Research Lab, or HRL, Sasha’s case is not unique. Since the invasion of Ukraine in February of 2022, Sasha is among thousands of Ukrainian children forcibly relocated to Russia for “re-education” and forced adoption. 

Nathaniel Raymond and Kaveh Khoshnood, HRL’s executive director and faculty director respectively, presented their findings at the United Nations Trusteeship Council Chamber in New York City on Feb. 22. Their presentation documented the widespread relocation, re-education and forced adoption of Ukrainian children like Sasha, which they argued violates international human rights law. 

“The United Nations has a critical role to play in responding to the evidence presented in the HRL report,” Raymond told the News. “If one message was taken away from my presentation, it was that the U.N. needs to act now. And that will require a full court press diplomatically on Russia, primarily by those nations that have not yet condemned the invasion.”

Raymond and Khoshnood spoke at a day-long session detailing Russian humanitarian abuses during the invasion of Ukraine, hosted by the permanent Ukrainian Mission to the United Nations. The event was attended by U.S. Ambassador to the U.N. Linda Thomas-Greenfield, former Ukrainian prisoners of war and foreign ministers from around the world.

Raymond and Khoshnood participated in the event’s afternoon panel, which focused on violations of children’s rights in the invasion. The panel was moderated by Dora Chomiak, president of the Ukrainian humanitarian aid organization Razom. 

Alongside the HRL researchers, the panel featured several speakers, including Hadja Lahbib, who is the Minister of Foreign Affairs of Belgium, and Kimberly Kagan, the founder of the Institute for the Study of War. 

“This was a golden opportunity for an academician like me with a passion to ensure our research findings can potentially translate into policy and practice,” Khoshnood told the News. “I hope our evidence-based report convinces U.N. leadership that gross human rights violations are taking place in Ukraine, and Russia must be held accountable for war crime[s].”

Their presentation highlighted the HRL report’s findings: a widespread Russian initiative to deport, “re-educate” and, in some cases, forcibly resettle over 6,000 Ukrainian children through a network of over 43 facilities. 

Using satellite imagery coupled with social media messages from Russian officials and parents searching for their children, the HRL team documented a relocation initiative stretching from Crimea to Siberia. 

“The scientific evidence, unfortunately, is clear: children, particularly infants and toddlers, can experience severe developmental and cognitive impacts from the kinds of abuses documented in this report,” Khoshnood said. “Youth of all ages can be highly susceptible to post traumatic stress disorder and other significant mental health effects.”

Khoshnood added that the report provides evidence of an “unfolding physical and mental health crisis” for Ukrainian children. 

Critically, Raymond said, the report’s estimates are “not the final figures.” The researchers believe that their estimate of 6,000 children in Russia’s custody is “quite low.” Other estimates at the panel ranged as high as 16,207 abducted children, ranging from four months to 17 years of age.

For Jeffrey Sonnenfeld, the School of Management professor whose research has investigated the exodus of companies from Russia after its invasion of Ukraine, that scale was shocking.

“How could this be in the 21st century?” Sonnenfeld told the News. “This is just one more piece of evidence to say that [Putin is] … targeting civilian populations.”

Raymond also noted that HRL’s identification of 43 facilities within the relocation network is likely “extremely low.” Due to the time-sensitive need to issue the report, Raymond added that over two dozen camps under investigation were not included in the final HRL study.

“We’re not talking about one minister,” Raymond said. “We’re not talking about one governor. We’re talking about a massive, systematic network that involves every level of Russia’s administration.”

Referring to the fourth Geneva Convention, Raymond issued a number of demands for Russia to comply with human rights law. 

First, he emphasized the need for Russia to register the children in its camps. The scholars highlighted that Russia’s foremost priority should be to systematically account for every child in its network, since researchers are unclear as to the scale of the relocation initiative.

Secondly, Raymond emphasized the need for communication between children and the outside world. According to Raymond, many children had their phones taken when entering the system, preventing them from contacting their loved ones. 

“They need to be able to phone home,” Raymond announced. “It’s time for them to be able to call mom and dad. And that is actually required under the Geneva Convention.”

Raymond also underscored the necessity for Russia to allow international monitors inside the camps. Overall, however, Raymond called for the children to be moved out of Russia entirely, so that they cannot be “used as weapons of the war.”

Thomas-Greenfield also spoke during the event, citing Yale’s report while discussing Russia’s forced relocation of children.

“We must call on Russia to end this inhumane campaign,” Thomas-Greenfield said. “Russia must provide a registration list of the children it has removed and allow independent observers inside Russia itself — the U.S. condemns credible reports of child relocation.” 

Since the report’s release, it has also been cited by Vice President Kamala Harris and Secretary of State Antony Blinken in calls to investigate atrocities committed in Ukraine. 

A State Department press release on the report declared the relocation network a “grave breach of the Fourth Geneva Convention” and called for Russia to “immediately halt” transfers and deportation, to return children to their families, to provide registration lists of the children and to grant outside independent observers access to the network’s facilities.

According to Katya Pavlevych, a Ukrainian activist and volunteer for Razom present at the U.N. meeting, reports of Russian child deportations first started emerging last summer.

Pavlevych spoke to the News about prejudiced attitudes and stereotypes held by Russian foster families toward Ukrainian children — intensified by training for adoptive parents in which they are told to treat Ukrainian youth as “manipulative” and “sneaky.”

After seeing Russian press releases about the Russian Commissioner for Children’s Rights — the purported architect of the relocation program — adopting Ukrainian children and shifting their “hostile attitude” into “love” for Russia, Pavlevych felt compelled to get involved in advocacy against the deportations.

“When you hear all that, and you see the person saying that in front of you, you realize that this is not a fictional character,” Pavlevych told the News. “It’s not a title in the magazine. It’s a real person. It could be you.”

While Pavlevych was “honored” to speak at the event, she hoped that the U.N. would respond faster and more effectively to issues surrounding Russia’s war in Ukraine.

“It is obvious now that U.N. agencies don’t have leverage mechanisms to force Russia to cooperate,” Pavlevych told the News. “So I am looking forward to seeing what new mechanisms they will introduce to deliver on their mission of helping children.”

According to Raymond, HRL’s U.N. presentation was a starting point for “broader multilateral and bilateral conversations” with other U.N. member states. 

Two days after the presentation, the HRL team shared its findings with a coalition of member states, including Denmark, the Netherlands and Australia, that supported accountability processes for Russia.

“Now’s the time to press all the buttons on the elevator,” Raymond told the News. “We have to use every single avenue at our disposal to attempt to get these kids home. And right now, that does mean the United Nations. And it means bilateral diplomatic pressure from the community of nations, outside of the U.N. And it means the use of intergovernmental organizations.”

The United Nations was founded in 1945.

Yash Roy and Yurii Stasiuk contributed reporting

The post YSPH professors present on Russian war crimes at United Nations appeared first on Yale Daily News.

The report — published on Feb. 14 by YSPH’s Humanitarian Research Lab as part of the State Department-funded Conflict Observatory program — documented the relocation of over 6,000 children from Ukraine via a network of 43 re-education and adoption facilities stretching from Crimea to Siberia. 

According to the report, the majority of camps engage in pro-Russia re-education initiatives, while others have given children military training and prevented their return to their parents — violating international human rights law.

“We were able to clearly identify immediately that the activities that Russia’s officials were describing were violations of the Fourth Geneva Convention,” said Nathaniel Raymond, executive director of the HRL. “In some cases, there were also alleged crimes against humanity in violation of the 1998 Rome Statute, on prohibitions of transfer of children from one group to another for the purposes of erasing national identity.”

According to Raymond, the research team had been “watching” the relocation program since early Spring 2022 — shortly after Russia’s invasion of Ukraine — and was a “clear priority” for the U.S. government. By October or November, the HRL researchers had developed the methodology and data sources to begin documenting the transfer of Ukrainian children. 

To do so, Raymond noted that HRL used open-source information to develop their understanding of the network of relocations, camps, re-education efforts and adoption and foster placements. HRL identified facilities through social media posts, government announcements and news reports. They also obtained public telegram messages from Russian officials and from Ukrainian parents who shared potential information about the children’s whereabouts.

The research team then verified these locations using high resolution satellite imagery of suspected camp locations, according to Raymond. A combination of the satellite imagery, reference photographs and videos on camp websites, along with user-generated photos on mapping sites like Yandex Maps, were employed to geolocate camp facilities. Each location was independently confirmed by at least two researchers before being included in the report.

To accomplish the task of large open-source research, the HRL worked with a research group across the University. Although, according to Raymond, the names of team members and group sizes could not be disclosed for security reasons, he emphasized that individuals from multiple parts of the University were involved.

“Yale students should know there are heroes among [them],” Raymond said. “You may not know who they are, but when you see this work, you should be proud of it. Because it’s your colleagues and fellow Yalies who are making it happen.”

The HRL was able to conduct open-source research because, rather than concealing the relocation networks’ existence, the Russian officials involved celebrated it. According to the report, the camps were marketed as either recreational or humanitarian: to provide kids with vacations or to save them from active warzones. 

As a result, many officials “celebrate” their involvement in social media posts, interviews to media outlets or photographs with Ukrainian children at Russian-controlled facilities.

“They really believe that somehow Ukraine should not exist, that Russia has the right to rule the territory that is Ukraine and that the people in that territory should be Russian,” said David Simon, director of the Genocide Studies Program who was not involved in the study. “The reason why I think that they’re so unabashed in saying what they’re doing is that … they don’t believe in Ukraine.”

The report’s findings, however, paint an even more grim picture. 

Since the Russian invasion of Ukraine on Feb. 24, 2022, more than 6,000 Ukrainian children have been held in Russia’s custody across at least 43 facilities, including a psychiatric hospital and a family center. The network stretches from Russian-occupied Crimea to Siberia: a camp in Magadan — 3900 miles away from Ukraine’s border — is closer to the United States than Ukraine. 

The true number of children and camps, Raymond added, is likely “significantly higher.”

According to the report, 78 percent of camps were engaged in “systematic re-education efforts” that exposed Ukrainian children to pro-Russia academic, cultural and in some instances, military-style training. Multiple camps are advertised as “integration programs” to assimilate Ukrainian children into the Russian government’s “vision of national culture, history, and society.”

At least two camps hosted orphaned children and placed them with Russian foster families. More than 20 of those Ukrainian children were placed with families in Moscow and enrolled in local schools.

According to the report, the network is centrally operated by Russia’s federal government, including local, regional, and federal leaders at every level of government. At least 12 of the individuals involved in the program are not currently on United States or international sanctions lists.

“It’s tragic to say this, but on virtually every front, whatever the official Russian press release is, the one thing you can count on is that the opposite is true,” said Jeffrey Sonnenfeld, SOM assistant dean. His research team has investigated the exodus of companies from Russia after its invasion of Ukraine.

In many instances, the report continued, consent from Ukrainian childrens’ parents were obtained under duress. The report details how parents were made to sign over power of attorney, how agreed-upon terms of stay lengths were violated and parents’ refusal to allow their children to attend camps “were ignored” by organizers. 

In at least four camps — including Medvezhonok which hosts at least 300 Ukrainian youth — childrens’ returns to their parents were suspended, and they are being held past their scheduled date of return. Parents also report being unable to obtain information about their children’s whereabouts after their return is delayed.

“It’s worse than misinformation: it’s disinformation,” Sonnenfeld said. “It’s intentional deceit, and that’s what we have here. And this is just one more piece of evidence to say that [Putin is] … targeting civilian populations.”

According to Raymond, the systematic relocation, re-education and resettlement of Ukrainian children is “absolutely” a prima facie violation of human rights and the laws of war. 

He underscored that point, especially, since he believes that the “number of locations and children is significantly higher”— a theory he intends to prove.

The report emphasized that the program’s adoption, unnecessary transfer, political indoctrination, military training and prolonged custody without parental consent of Ukrainian minors may constitute potential violations of the Convention on the Rights of the Child and the Geneva Conventions. 

Simon also pointed out Article 2(e) of the United Nations Convention on the Prevention of the Crime of Genocide, which includes “forcibly transferring children” of one group to another as one of the crimes that constitute genocide.

“Russia even changed its adoption laws to make it easier to adopt Ukrainian kids and transfer those Ukrainian kids to Russia, so that they may be raised as Russian kids,” Simon told the News. “That’s what forcibly transferring children of a group to another group means. There are only five sets of acts that qualify under that convention, and it’s one of them.”

For some Ukranian students at Yale, the report was startling. 

According to Sofiya Bidochko ’24, a Ukrainian-American student whose extended family lives in Ukraine, the report’s documentation of Russian mass-relocation and re-education initiatives makes her “sick to [her] stomach”

“I grew up learning about my great great grandfather being forcibly sent to his death to a labor camp in Siberia and I questioned how such an act was ever allowed to be permitted by the world,” Bidochko wrote to the News. “And now I learn of these poor children who are also sent to ‘reeducation’ camps … all of them being forced into an identity meant to erase them of being Ukrainian, and I cannot comprehend how this is not being stopped before our eyes.”

Moving forward, Raymond and the HRL hope to continue investigating humanitarian crises in Ukraine. While Raymond mentioned an additional investigation on another Ukraine-related crisis slated to be published next month, he emphasized how the report has had a “catalytic effect.”

On Wednesday, Feb. 22, Raymond and Kaveh Khoshnood, the faculty director of the HRL, will present their findings at a United Nations summit addressing atrocities committed by Russia in Ukraine. 

While Khoshnood understands that the report might not immediately cause a change in policy, he remains optimistic about the research that his team conducts. 

“We do however know that such evidence-based reports do not always “translate” into appropriate policy and practice changes,” Khoshnood wrote to the News. “This is a challenge that public health academicians typically experience on many topics, but regardless of this challenge, we will do our best.”

Since the report’s release, it has been cited by Vice President Kamala Harris and Secretary of State Anthony Blinken in calls to investigate atrocities committed in Ukraine. 

A State Department press release on the report declared the relocation network a “grave breach of the Fourth Geneva Convention” and called for Russia to “immediately halt” transfers and deportation, to return children to their families, to provide registration lists of the children and to grant access to outside independent observers to the network’s facilities. 

The Conflict Observatory was announced by the State Department on May 17, 2022.

The post YSPH research reveals relocation and re-education of Ukrainian children appeared first on Yale Daily News.

Now, as the incoming dean of the Yale School of Public Health, Ranney looks to draw on experiences that have taken her across the globe, blending pursuits in public health, emergency medicine and firearm violence reduction to advance health outcomes. She will begin her term at YSPH on July 1. 

“We have the opportunity to set a model for schools of public health across the country, and hopefully, across the globe, around how to think differently about who’s part of the work of public health and the study of public health,” Ranney told the News. “I want us to be the best at research and to have the best students, but the thing that I care most about is that we actually change health outcomes for communities. And to me, that’s the ultimate metric of my deanship.”

Ranney arrives at Yale from Brown University, where she serves as the deputy dean of the Brown University School of Public Health and a professor of behavioral and social sciences and health services. 

Long before that, Ranney began her career at Harvard, where as an undergraduate she examined the link between social determinants and healthcare as a history of science major. Internalizing the maxim that “all medicine is political,” Ranney grew to understand how deeply healthcare is intertwined with social structures — a philosophy that led her to enlist as a Peace Corps volunteer in West Africa combating the HIV/AIDS epidemic following graduation.

“I did a lot of work while I was there around gender based violence as a form to prevent the spread of HIV,” Ranney said. “But then at the end of the day, when people did catch the virus, they didn’t want to get diagnosed. They wouldn’t say its name … couldn’t get treated. It was basically a death sentence.”

The experience led Ranney towards a passion for understanding the “underlying structural factors” that determine access to healthcare. On her return to the U.S., Ranney attended medical school at Columbia University and completed her residency in emergency medicine at Brown. 

By the time she was in medical school, Ranney admitted, she wanted to get a degree in public health but was reluctant to pay for it herself. That dilemma, she explained, drives a commitment to financial accessibility as a public health administrator. 

Her decision to pursue clinical practice in emergency medicine, however, soon proved impactful. Ranney explained that she was drawn to the specialty due to its role as the “safety net of our health care system.”

“We were on the front lines,” Ranney said. “It’s really the place where you see public health problems before the rest of society [and] the rest of our country sees [them].”

She recalled observing the increase in opioid overdoses and opioid use disorder prior to the rest of the country, adding that she and her team are also first hand witnesses to domestic violence and to the challenges unhoused people face.

Having obtained her master’s of public health and completed an injury prevention research fellowship at Brown, Ranney still regularly spends time in the emergency room as a clinician, a practice she hopes to continue at Yale on top of her deanship. 

Emergency medicine keeps Ranney’s “feet firmly on the reality of healthcare” and “all the ways in which … society does not promote health.” According to Ranney, the specialty allows her to monitor and detect crises in public health before they reach the rest of society. 

Ranney also sees the emergency room as a locus for equity; according to her, the ER is the only place in the U.S. healthcare system that is open to everyone, regardless of ability to pay. 

“We serve as the bellwether for the problems in the U.S. healthcare system,” Ranney said. “When you look at overcrowding, staffing issues, burnout, [and] issues with payment reform, [emergency medicine is] a harbinger of all of those as well. There are a few places in the healthcare system that see it firsthand as those of us that work in emergency medicine.”

Today, Ranney is widely recognized as an expert on gun violence as a public health crisis. Ranney has served as a co-founder and senior strategic advisor for the American Foundation for Firearm Injury Reduction in Medicine at the Aspen Institute. Locally, she serves on the board of directors for the Non-Violence Institute in Providence, Rhode Island.

The roots of her interest in preventing firearm violence, Ranney explained, are her experiences in emergency medicine. When Ranney entered the field in the mid-2000’s, the federal government had defunded the Center for Disease Control and Prevention and National Institutes of Health’s firearm injury prevention research, and few researchers had thought of addressing gun violence as a public health emergency. 

According to Ranney, treating victims of gun violence in the emergency room gave her “repeated lived experience” that compelled her research.

“I think there’s a very visceral knowledge of the effects of a bullet on a human body, on the human psyche and on the family and community around them,” Ranney said. “It changes a human, forever, even if they survive that bullet wound.”

Applying the same scientific methodology used to address heart disease or COVID-19, Ranney explained, is essential to reducing harm from firearms. She prides herself on bringing a degree of “scientific rigor” and methodological tools from across her career to the study of firearm harm reduction.

For Maame-Owusua Boateng SPH ’23, Ranney’s hybrid role as a doctor and a public health practitioner provides a model for students interested in combining public health and clinical medicine. Ranney’s combination of the fields creates a “holistic view” on how to address community healthcare and “create trust in communities that have reasons to distrust.”

Similarly, for Lauren Chin SPH ’23, Ranney’s work on addressing gun violence strikes a personal note, giving her optimism about the incoming dean.

“As someone who calls Monterey Park and East Los Angeles home and has witnessed gun violence in New Haven, this public health issue is too familiar to me,” Chin wrote to the News. “But Dr. Ranney understands the nuances between mental illness and gun violence and how to build solutions to gun injury such as community partnerships, something Yale needs to support more of in New Haven.”

Brown School of Public Health’s interim dean Ronald Aubert described Ranney as an “integral part of the Brown community” during her time in Providence. Ranney has been a “tireless advocate” for patients, students and colleagues while impacting “real-world issues facing patients.”

Aubert specifically recalled a moment where Ranney attended a Women in Public Health luncheon organized by Brown’s graduate student council. According to Aubert, her role within the community serves as an inspiration for women in the field.

“The impact that she has … brings a lot of warmth and a lot of encouragement to the women who are envisioning themselves as leaders in public health,” Aubert said. “And that’s a beautiful thing.”

As she arrives at Yale, Ranney has already had a similar impact on YSPH students.

“[Ranney] is one of the reasons I decided to pursue public health when I was exploring such a career field,” Chin wrote to the News. “I was torn between pursuing medicine (EM specifically at the time) or public health, but Dr. Ranney has demonstrated that it is possible to successfully combine work in both fields while simultaneously caring for colleagues.”

Although Ranney accepted the YSPH deanship less than a week before it was officially announced, she hopes to arrive at Yale with two major goals: to get to know YSPH, Yale and the New Haven community, and to successfully transition YSPH to an independent model. 

Ranney expects that it will take her at least a few months to get her bearings at YSPH. She hopes to spend her first few months understanding YSPH’s culture, budgeting and administration before collaborating with the YSM and YSPH leadership to set up a transition structure that is “nimble” and “fiscally responsible.”

Her colleagues at YSPH already look forward to her leadership.

“It’ll be very refreshing to have [Ranney] come here and help us advance what is already, what I like to say, a school of public health that punches way above its weight at this time,” said Howard Forman, professor of radiology and director of the YSPH Health Care Management program. “Hopefully, we can start beefing up, getting bigger, building, getting a building and continuing the evolution that we’ve had over the last decades.”

To do so, Ranney hopes to pursue three “big verticals.” First, she explained, she hopes to foster a sense of inclusivity within the school, to create a “space where all voices are heard” and where “diverse communities are equal partners in the work.”

While Ranney recognizes that tensions exist between Yale and the New Haven community, she aims to approach those conversations with respect and willingness to listen. In addition, Ranney emphasized the importance of “creating a system that walks the walk,” where institutions establish trust by proving themselves to communities. 

“One of my most deeply held, most consistent driving beliefs …  is that nothing that we do matters unless it is done with community members as partners.” Ranney said. “Not doing participatory research, which is deeply important, but true bidirectional partnerships where we have longitudinal trusted relationships with communities”

Secondly, Ranney intends to cultivate an emphasis on innovation and entrepreneurship within the sphere of public health. By collaborating with for-profit, nonprofit and government sectors — and by relying on her experience starting two successful nonprofits — Ranney aspires to “empower” faculty and foster a spirit of innovation.

Ranney’s third “vertical” emphasizes communication. She hopes to ensure that students and faculty are provided with the “tools and training” to serve as a clear resource for “accurate, timely and trusted communication.” In addition, she hopes to build up Yale’s existing research on gun violence prevention, collaborating with YSM and YSL researchers who are exploring the topic and developing research in the discipline.

“We’re at a moment of transformation,” Ranney said. “I think that this is a time where we have the opportunity across the nation and the globe in public health to be leaders in how we think about how we train people in public health, how we study public health and most of all, how we put public health into practice.”

For Melinda Irwin, chair of the search committee for the new YSPH dean, Ranney’s ability as a communicator and firearm injury reduction expert, as well as her excitement about collaborations across the University, distinguished her from over 100 other applicants. As Irwin and Ranney both indicated, Ranney was also a faculty member at the Brown School of Public Health during its separation from the Warren Alpert School of Medicine.

Ranney’s emphasis on underrepresented communities — from her desire to work clinical shifts in the ER to research on population health— demonstrated compassion for her patients and set her apart, according to Irwin. 

“I’m really looking forward to getting to know the New Haven community, the Connecticut community and then potentially getting our students and faculty to have those deep, respectful relationships,” Ranney told the News. “Because that’s at the core of public health — it’s about the public … It’s about creating a space where community partners are deeply heard.”

YSPH was founded in 1915.

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